Provider Demographics
NPI:1114115052
Name:ACTIVA REHAB THERAPY INC
Entity Type:Organization
Organization Name:ACTIVA REHAB THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:BEATRIZ
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:786-295-9334
Mailing Address - Street 1:7861 NW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3860
Mailing Address - Country:US
Mailing Address - Phone:786-295-9334
Mailing Address - Fax:305-556-9744
Practice Address - Street 1:7861 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3860
Practice Address - Country:US
Practice Address - Phone:786-295-9334
Practice Address - Fax:305-556-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH294OtherMEDICARE LEGACY
FLAH294Medicare PIN